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Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.
How do I find a surgeon specializing in severe capsular contracture deformity (which I have after 4 breast augmentations)?
There probably is not a surgeon specializing in severe breast capsular contracture. The next best thing is an older Board Certified Plastic Surgeon who has done a lot of breast surgery including reconstruction over the years and dealt with capsular contracture in the 80's and 90's. You will need the operative reports from your previous breast augmentations. The trick is to do something different to trick the body not to do the same thing again. This includes moving the implant and using a different implant surface. Go to the "Find a Surgeon" section of this web site or plasticsurgery.org and search for breast experience and then look at the age and their web site.
You can find a board certified plastic surgeon with experience, who will examine you and give you multiple options. Understand your options and potential risk.
While there isn't likely to be anyone specifically focusing on treatment of capsular contracture, there are some who have a special interest in revision surgery. Operating on a breast that has already had 4 surgeries and still has a problem does require special expertise. One thing that may be considered is the use of an acellular dermal matrix material so it might be helpful to ask about that as you are contacting board-certified plastic surgeons.
It really depends on a few factors that a qualified board-certified plastic surgeon can review with you. Recurrent capsular contracture can occur if the implants are in the sub-glandular pocket and this has not been changed with subsequent surgeries or even sometimes if the same implants are used. The plastic surgeon you see for a second opinion will need the details of your previous procedures in addition to an exam to best care for you. Although there aren't experts in capsular contracture treatment, some plastic surgeons perform more revision breast surgery and may have a bit more experience with adjunctive things such as acellular dermal matrix, etc. I hope this helps.
Yes, it sounds like you have a very difficult problem. If you are looking for a ASPS member with a vast amount of experience in the area of capsular contracture correction and/or the use of artificial dermis consider Dr. Patrick Maxwell of Nashville, TN or Dr. Scott Spear of Washington, DC. Please anticipate that these procedures will be rather expensive.
Gary R. Culbertson, MD, FACS
I'm sorry to hear about your troubles. If you've had 4 good surgeries, and your body has made capsules 4 times - I would consider taking the implants out, and not replacing them. You could perhaps consider the option of fat transfer to the breast. Dr. del Vecchio in Boston has done a lot of work on this option.
Alternatively, you could try placement of a material called Strattice next to a new implant. Early data shows a decreased capsule rate when this material is used.... but it's not a zero percent rate. Dr. Maxwell, in Nashville, is a proponent of this approach.
Surgeons Specializing in Severe Capsular Contracture Deformity – If you’ve had previous capsular contractures and you continue to have capsular contractures, the best option is to remove the implant and to consider autologous augmentation or removal without augmentation and lift only, depending on the amount of breast tissue that you have. If a patient has had more than two breast augmentations and capsular contractures the chances of increasing capsular contracture are significantly higher. It is best to not replace the implants and use autologous fat tissue as an option if the patient is amenable to this option.
I am very sorry to hear of your difficulty. Finding a board certified plastic surgeon who does many breast augmentations is likely also the most experienced at treating capsular contracture. After 4 breast augmentations removal of your implants and capsules followed by fat transplantation may be your best option. Even with textured implants and acellular dermis wrap your chances of a recurrent capsule with new implants is high.
I'm sorry you have has such an issue with recurrent capsular contracture. The first place to start is a comprehensive history of your previous breast surgery to include incisions used, placement of your implant(s) above or below the muscle, any problems you have had with surgeries (infections, bleeding, etc.). Once your board-certified plastic surgeon has had a chance to meet with you, examine you and go over your history. he or she can make recommendations for what procedure(s) will be best to help decrease your risk of recurrent capsular contracture. In my practice which includes a lot of revision surgery, the things I have found helpful in avoiding or treating capsular contracture include avoiding the areolar approach, placing implants partially under the muscle, a triple antibiotic irrigation in the operating room, and the use of an acellular dermal matrix like Strattice. This is a lot of information I realize and your plastic surgeon may have done all of these things. In rare cases the right thing to do is to remove the implants and consider other alternatives such as fat grafting. I would recommend you search for a board-certified plastic surgeon who does more revision surgery who can properly guide you.
I wish you well
Michael C. Edwards, MD, FACS
President – American Society for Aesthetic Plastic Surgery
President - Clark County Medical Society
Anson, Edwards & Higgins Plastic Surgery Associates
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Las Vegas, Nevada 89113
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This is a very good question and not an uncommon one. Four previous surgeries is significant and you certainly need someone with experience. You really have to research the plastic surgeons in your area, look at pictures, review sites like realself.com. The state of the art today is to consider a dermal matrix separate the scar tissue. Good luck